Mystery solved: Keep your white coats. And your sleeves.

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Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.

Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.

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My research staff recently came across a paper that directly addressed this problem. As they say on the Internet, “The results will make your jaw drop.”

The controversy continues. A recent issue of the newsletter “Inside the Joint Commission” suggested that hospitals consider getting rid of white coats. Curiously, it then said that if white coats continued to be used, they should ideally be laundered every day adding that laundering white coats daily is impractical and the cost would be prohibitive. The article certainly didn’t clarify anything.

About four years ago, I addressed this topic on my personal blog and observed that, “the white coat may be contaminated with bacteria, but whatever one wears may also be contaminated. What is the difference between wearing a white coat for few days and wearing a suit jacket or a pair of pants for a few days?”

My research staff recently came across a paper that directly addressed this problem. A group from the University of Colorado and Denver Health conducted a randomized prospective study of internal medicine residents and hospitalists comparing bacterial contamination of the clothing of 50 doctors wearing freshly laundered short-sleeved uniforms to 50 wearing white coats laundered at intervals of weekly or longer.

As they say on the Internet, “The results will make your jaw drop.”

No significant differences were found between the bacterial colony counts cultured from white coats compared to newly laundered uniforms, and no differences were found between the two groups when wrists, sleeve cuffs, or pockets were cultured.

Colonies of methicillin-resistant staph aureus were found in similar numbers when the sleeves of both types of clothing and wrists of the subjects in both groups were cultured.

Another interesting finding was that although the newly laundered uniforms were nearly devoid of bacteria before they were worn, “by 3 hours of wear nearly 50% of the colonies counted at 8 hours were already present.”

The authors concluded that reducing bacterial contamination of healthcare personnel attire made of conventional fabrics would require changing work clothes every few hours.

They also stated, “Our data do not support discarding long-sleeved white coats for short-sleeved uniforms that are changed on a daily basis.”

We are still awaiting evidence that the so-called “bare below the elbows” rule for healthcare workers in the United Kingdom has reduced the incidence of hospital-acquired infections.

Even infectious disease specialists can’t agree about whether the policy works. After a debate on the subject at last year’s Infectious Disease Week meeting, a straw poll of ID docs showed that 58% sided with the doctor who supported the wearing of white coats.

By the way, here’s a table from the Colorado randomized trial showing how frequently the physicians in the white coat group laundered their coats.

None of the colony count or MRSA differences are significant. It didn’t matter how often they were cleaned.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last six years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 2,500,000 page views, and he has over 15,500 followers on Twitter.

1 Comment

Melissa Stewart, Ph.D
on June 23, 2016 at 2:06 pm

Interesting article! As a physician coach and patient experience consultant, I view the white lab coat from the patients’ perspective and their feelings are rather clear- patients want physicians to wear a white lab coat and indicate the traditional garb builds confidence and trust in a provider. In a study by Rehman et al (2005) patients responded to what they prefer a physicians to wear. Here are the results:
Favored white lab coat 76.3%
Surgical scrubs 10.3%
Business dress 8.8%
Casual 4.7%
Their findings correlated significantly to the degree of trust and confidence in physician.